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Ophthalmology
Progressive myelination of the retinal nerve fibre layer associated with a lamina cribrosa cleft
  1. Pryce Payne1,
  2. Greg Nel2 and
  3. Jesse Gale1,3
  1. 1Department of Surgery and Anaesthesia, University of Otago Wellington, Wellington, New Zealand
  2. 2Black Gates Optometrists, Lower Hutt, New Zealand
  3. 3Capital Eye Specialists, Wellington, New Zealand
  1. Correspondence to Dr Jesse Gale; jesse.gale{at}gmail.com

Abstract

Myelination of the retinal nerve fibre layer (MNFL) is generally an incidental asymptomatic finding on fundus exam. While MNFL is thought to be a congenital and stationary finding, there have been cases of acquired and progressive MNFL reported. Here, we discuss a case where a girl in middle childhood presented with reading difficulties and was found to have normal vision and MNFL superior to the left optic disc. Over 5 years, the MNFL was observed to grow, and a new patch appeared inferior to the left disc. A Y-shaped cleft was detected in lamina cribrosa. The shape of the cleft suggested incomplete embryological closure of the optic cup and optic stalk. This case offers support for the concept that defects in lamina cribrosa allow oligodendrocyte precursor cells to enter the retina, where they may later proliferate and differentiate to form MNFL.

  • Neuroopthalmology
  • Visual pathway
  • Pathology

https://doi.org/10.1136/bcr-2024-262768

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: PP, GN, JG. The guarantor is JG.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.